Washington-Watch

States' ACA Affinity Affects Mental Health Access

WASHINGTON -- Access to mental health services will be helped when major provisions of the Affordable Care Act (ACA) come online early next year, but access will be limited in states not enthusiastic about the law, mental health advocates here said.

For example, states that are more actively building and operating the law's health insurance exchanges can work to ensure sound mental health benefits are included in plans selling on the exchanges and proper outreach is conducted to communities most at risk, said Ted Lutterman, senior director of government and commercial research at the National Association of State Mental Health Plan Directors' Research Institute in Falls Church, Va..

"In some of the states where the governor is staying away from the exchange, our mental health agencies are not able to be as actively engaged in all the enrollment engagement, benefits package, and other important services, as in the states where the state is building the exchange," Lutterman told MedPage Today afterward.

Twenty-seven states will allow the federal government to build and operate their health insurance exchange, where the uninsured will be able to shop online for qualified health plans that sell on the exchanges. Seventeen states and the District of Columbia are doing it themselves.

"States that are building the exchange are much more able to affect how mental health will fit into it," Lutterman said.

Medicaid is the largest payer of mental health in the U.S. But less than half of all the states will expand their programs under the ACA, after the Supreme Court made it optional last summer. The ACA had hoped to cover all those making up to 138% of the federal poverty level with Medicaid.

Lutterman presented data from the Substance Abuse and Mental Health Services Administration (SAMHSA) showing nearly a million people in the Medicaid expansion population (5.4%, 95% CI 4.9%-5.9%) have a serious mental illness. Another 3.8 million (21.3%, 95% CI 20.3%-22.4%) have any mental illness.

With many states choosing not to expand Medicaid, those individuals are shut out of access to services.

Adults who weren't receiving mental healthcare but needed it in the past year cited cost about half the time as the reason for not obtaining help, according to a 2012 survey by SAMHSA.

Health insurance not covering enough treatments was cited 8.3% of the time and not covering any treatment 6.7% of the time, Lutterman said.

"Those are issues that we think will greatly benefit from the parity act which is supposed to take affect with the Affordable Care Act," he said.

The parity law aims to ensure that when coverage for mental health and substance use conditions is provided, it is generally comparable to coverage for medical and surgical care.

The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act of 2008 by requiring coverage of mental health and substance use disorder benefits for millions of Americans in the individual and small group markets who currently lack these benefits, and expanding parity requirements to apply to millions of Americans whose coverage did not previously comply with those requirements.

David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.

This survey is a poll of those who choose to participate and are, therefore, not valid statistical samples, but rather a snapshot of what your colleagues are thinking.

ADVERTISEMENT

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.